Division of Burns, Trauma and Acute Care Surgery, Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA.
Eur J Trauma Emerg Surg. 2023 Oct;49(5):2295-2303. doi: 10.1007/s00068-023-02317-6. Epub 2023 Jul 5.
Early enoxaparin 30 mg BID administration at 24 h post-injury has been demonstrated in patients with traumatic brain injury (TBI). However this dose can also yield subtherapeutic anti-Xa levels in 30-50% of trauma patients, suggesting that larger doses may be required for adequate prophylaxis against venous thromboembolism (VTE). The safety of enoxaparin 40 mg BID in trauma patients has previously been shown - however, these studies have largely excluded TBI patients. Therefore, we sought to demonstrate the safety of early enoxaparin 40 mg BID in a low-risk group of TBI patients.
A retrospective review of TBI patients at a Level 1 trauma center was performed. Patients with stable computed tomography (CT) of the head at 6 to 24 h post-injury who received enoxaparin 40 mg BID were included and serial GCS evaluations to identify possible clinical complications. To evaluate the safety of this dosing regimen, data was then compared to patients from our institution with similar TBI profiles who had received 5,000 units (U) of subcutaneous heparin (SQH) prophylaxis.
199 TBI patients were identified over a nine month period, 40/199 (19.7%) received DVT prophylaxis after traumatic injury. Of these 40, 19 (47.5%) received enoxaparin 40 mg BID and 21 (52.5%) received 5,000U of SQH. Low risk TBI patients who were either given enoxaparin (n = 7) or SQH (n = 4), demonstrated no clinical decline in mental status during their inpatient stay.
Prior studies have demonstrated that enoxaparin 40 mg BID dosing is superior to traditional VTE prophylaxis in trauma patients. However, TBI patients are often excluded from this dosing due to concern for progression. Our study showed no clinical decline in mental status in a small cohort of low-risk TBI patients who received enoxaparin 40 mg BID.
在创伤性脑损伤（TBI）患者中，伤后 24 小时内早期给予依诺肝素 30mg，bid 治疗已得到证实。然而，在 30%至 50%的创伤患者中，这种剂量也可能产生低于治疗水平的抗 Xa 水平，这表明需要更大剂量才能充分预防静脉血栓栓塞症（VTE）。依诺肝素 40mg，bid 在创伤患者中的安全性此前已得到证实-然而，这些研究在很大程度上排除了 TBI 患者。因此，我们试图证明依诺肝素 40mg，bid 在 TBI 患者的低风险组中的安全性。
对 1 级创伤中心的 TBI 患者进行回顾性分析。伤后 6 至 24 小时头部 CT 稳定的患者接受依诺肝素 40mg，bid 治疗，并进行连续 GCS 评估以确定可能的临床并发症。为了评估这种给药方案的安全性，将数据与我院具有类似 TBI 特征的接受 5000 单位（U）皮下肝素（SQH）预防的患者进行比较。
在 9 个月的时间内确定了 199 例 TBI 患者，其中 40/199（19.7%）在创伤后接受了 DVT 预防。在这 40 例中，19 例（47.5%）接受了依诺肝素 40mg，bid 治疗，21 例（52.5%）接受了 5000U 的 SQH。接受依诺肝素（n=7）或 SQH（n=4）的低危 TBI 患者在住院期间的精神状态没有临床下降。
先前的研究表明，依诺肝素 40mg，bid 剂量优于传统的创伤患者 VTE 预防。然而，由于担心进展，TBI 患者通常被排除在这种剂量之外。我们的研究表明，在接受依诺肝素 40mg，bid 的小队列低危 TBI 患者中，精神状态没有临床下降。
